Bill Text: TX HB142 | 2025-2026 | 89th Legislature | Enrolled

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Bill Title: Relating to the Health and Human Services Commission's office of inspector general, the review of certain Medicaid claims, and the recovery of certain overpayments under Medicaid.

Sponsorship: Partisan Bill (Republican 3)

Status: (Passed) 2025-05-29 - Effective on 9/1/25 [HB142 Detail]

Download: Texas-2025-HB142-Enrolled.html

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H.B. No. 142

AN ACT
relating to the Health and Human Services Commission's office of
inspector general, the review of certain Medicaid claims, and the
recovery of certain overpayments under Medicaid.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 544.0106, Government Code, is amended to
read as follows:
Sec. 544.0106. PROCUREMENT OF [CONTRACT FOR REVIEW OF
INVESTIGATIVE FINDINGS BY] QUALIFIED EXPERT ON BEHALF OF OFFICE OF
INSPECTOR GENERAL. A qualified expert retained by the commission
on behalf of the office of inspector general is considered an expert
witness for purposes of Section 2151.005 [(a) If the commission
does not receive any responsive bids under Chapter 2155 on a
competitive solicitation for the services of a qualified expert to
review investigative findings under Section 544.0104 or 544.0105
and the number of contracts to be awarded under this subsection is
not otherwise limited, the commission may negotiate with and award
a contract for the services to a qualified expert on the basis of:
[(1) the contractor's agreement to a set fee, either as
a range or lump-sum amount; and
[(2) the contractor's affirmation and the office of
inspector general's verification that the contractor possesses the
necessary occupational licenses and experience].
[(b) Notwithstanding Sections 2155.083 and 2261.051, a
contract awarded under Subsection (a) is not subject to competitive
advertising and proposal evaluation requirements.]
SECTION 2. Subchapter C, Chapter 544, Government Code, is
amended by adding Section 544.0115 to read as follows:
Sec. 544.0115. PERMITTED DISCLOSURE OF CERTAIN
INFORMATION. For purposes of performing the duties of the office of
inspector general under this subchapter, the office may disclose
information obtained in the course of conducting the office's
administrative oversight activities to:
(1) a federal, state, or local governmental entity,
including:
(A) a federal agency or an agency of this state or
another state;
(B) the criminal, civil, or administrative
department, division, bureau, or other entity with enforcement or
prosecutorial authority of:
(i) this state;
(ii) the United States;
(iii) another state; or
(iv) a local governmental entity of this
state or another state; and
(C) a political subdivision of this state; or
(2) a person authorized by the office to receive the
information.
SECTION 3. Section 544.0153(b), Government Code, is amended
to read as follows:
(b) Except as required by federal law, to [To] determine a
health care professional's eligibility to participate as a Medicaid
provider, the office of inspector general may not conduct a
fingerprint-based criminal history record information check of a
health care professional who the office has confirmed under
Subsection (a) is licensed and in good standing. This subsection
does not prohibit the office from conducting a criminal history
record information check of a provider that is required or
appropriate for other reasons, including for conducting an
investigation of fraud, waste, or abuse.
SECTION 4. Section 544.0202(b), Government Code, is amended
to read as follows:
(b) The commission shall:
(1) aggressively publicize successful fraud
prosecutions and fraud-prevention programs through all available
means, including the use of statewide press releases; and
(2) ensure that the commission or a health and human
services agency maintains and promotes an appropriate
communications system [a toll-free telephone hotline] for
reporting suspected fraud in programs the commission or a health
and human services agency administers.
SECTION 5. Section 544.0504, Government Code, is amended to
read as follows:
Sec. 544.0504. RECOVERY AUDIT CONTRACTORS. (a) To the
extent required under Section 1902(a)(42), Social Security Act (42
U.S.C. Section 1396a(a)(42)), the commission shall establish a
program under which the commission contracts with one or more
recovery audit contractors to:
(1) identify Medicaid underpayments and overpayments,
including underpayments and overpayments under the Medicaid
managed care program; and
(2) recover the overpayments.
(b) An overpayment under Subsection (a)(2) may be recovered
from either the provider or the managed care organization.
(c) A recovery audit contractor may not:
(1) initiate a review of a claim unless:
(A) the office of inspector general or the
office's designee:
(i) determines that the review would be
cost-effective; and
(ii) approves the review; and
(B) at least one year has elapsed since the date
the claim was received; or
(2) initiate a recovery effort on a claim if a managed
care organization has notified the office of inspector general that
the organization is auditing the claim.
(d) On request by a recovery audit contractor or the office
of inspector general, a managed care organization or provider who
is the subject of a review conducted under this section shall submit
to the contractor or office all information necessary to perform
the review not later than the date specified in the request. All
information and materials obtained under this section are
confidential under Section 544.0259(e).
(e) The executive commissioner by rule shall adopt a process
for appeals related to overpayments identified by a recovery audit
contractor under this section.
(f) The commission may contract with a third party to
administer Subsection (b) or the appeals process adopted under
Subsection (e).
(g) The executive commissioner, in consultation with the
office of inspector general, may adopt rules necessary to implement
this section.
SECTION 6. The following provisions of the Government Code
are repealed:
(1) Section 544.0201; and
(2) Section 544.0252(a).
SECTION 7. If before implementing any provision of this Act
a state agency determines that a waiver or authorization from a
federal agency is necessary for implementation of that provision,
the agency affected by the provision shall request the waiver or
authorization and may delay implementing that provision until the
waiver or authorization is granted.
SECTION 8. The Health and Human Services Commission is
required to implement a provision of this Act only if the
legislature appropriates money specifically for that purpose. If
the legislature does not appropriate money specifically for that
purpose, the commission may, but is not required to, implement a
provision of this Act using other money available to the commission
for that purpose.
SECTION 9. This Act takes effect September 1, 2025.
______________________________ ______________________________
President of the Senate Speaker of the House
I certify that H.B. No. 142 was passed by the House on April
16, 2025, by the following vote: Yeas 144, Nays 0, 1 present, not
voting; and that the House concurred in Senate amendments to H.B.
No. 142 on May 19, 2025, by the following vote: Yeas 123, Nays 1, 1
present, not voting.
______________________________
Chief Clerk of the House
I certify that H.B. No. 142 was passed by the Senate, with
amendments, on May 8, 2025, by the following vote: Yeas 31, Nays 0.
______________________________
Secretary of the Senate
APPROVED: __________________
Date
__________________
Governor